- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,324.03 / $2,747.00 / $4,456.00
| Facility | | $1,324.03 | $2,747.00 | $4,456.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $414.34 / $666.61 / $1,832.00
| Professional | | $414.34 | $666.61 | $1,832.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $400.79 / $524.19 / $629.03
| Professional | | $400.79 | $524.19 | $629.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $540.41 / $607.16 / $5,851.00
| Professional | | $540.41 | $607.16 | $5,851.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $461.29 / $503.22 / $587.09
| Professional | | $461.29 | $503.22 | $587.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.00 / $1,981.00 / $1,981.00
| Facility | | $1,981.00 | $1,981.00 | $1,981.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.05 / $524.19 / $650.82
| Professional | | $402.05 | $524.19 | $650.82 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $472.22 / $2,575.00 / $6,124.00
| Professional | | $472.22 | $2,575.00 | $6,124.00 |